Breaking Through the Telemedicine Payment Barrier

Doctor A and Doctor B see two patients simultaneously. Both patients have come in for a follow up visit on their recent knee surgeries. Both doctors speak with their patients for 15 minutes, asking about the recovery, if the patient has any abnormal pain, and observing the leg for any visible redness or abnormal swelling. Both patients are recovering well, are pain free, and look to be avoiding infection. The doctors both advise their patients to continue on as they have been, and to come back in another month for another follow up appointment. The patient outcome is the same in both scenarios. Doctor A gets a check from the insurance company as usual. Doctor B submits for payment to the insurance company as well and is denied payment. Doctor A gets paid and Doctor B is left holding the bag saying, “Show me the money.” The difference? Doctor A sees his patient in person, while Doctor B sees her patient through the use of a video conferencing system.

It’s amazing to think that telemedicine has been around for nearly 40 years. Of course, the technology used back then was markedly different than today’s high definition audio video teleconferencing systems. Yet despite these innovative leaps in technology, one thing has remained rather constant. The insurance companies have not paid telemedicine claims in the same way as in person visits, and sometimes, haven’t agreed to pay for them at all. This lack of payment has been a major problem in the adoption and proliferation of telemedicine systems in general.

Today however, all that is changing at a quicker pace than ever before.

There are two main reasons that the tide is shifting in favor of telemedicine, creating what Forbes called a “perfect storm” for the rapid adoption of telemedicine as a viable way to reduce health care costs and better leverage the limited resources of our physicians’ time.

Federal Regulation

To start, the Affordable Care Act, or ACA, is redefining the way we evaluate medical care. It is moving our insurance payer model from a “fee for service model” to one based on patient outcomes. According to Shahid Shah, CEO of Netspective, also known as “The Healthcare IT Guy”, “the idea is not the services that the provider performs and gets fees paid for; instead it is the outcome that the services provide that is of significance.” It is this focus on outcomes that means “Physicians will get paid for emails and phone visits in the same way they get paid for in-person visits…”

Besides the ACA, the Medicaid program is also creating opportunities for telemedicine to proliferate as well by defining care standards for “the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.” They in turn are encouraging states “to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology.”

State Legislation

Given the efficiencies of telemedicine, the need for health care reform, and the directives of federal programs like Medicaid above, the states have indeed been leveraging their power as well to change the way insurance companies are approaching payments.

In fact, currently 27 states now have laws in place to assure that telehealth is treated similarly to in person visits from a payment perspective. The three latest states to pass this legislation were Indiana, Minnesota, and Nevada. There are currently 8 other states in the process of this type of legislation as well. Given those bills are passed with equal fervor, it seems 35 states and Washington DC will all have some type of telemedicine legislation in effect by the end of the year. Of course not all states are implementing this equally, so the American Telemedicine Association has created a resource center to help educate us on the differences.

It has been shown through several studies that Americans are ready and willing to start to leverage telemedicine to take control of their health. Unfortunately, despite the patient’s desire to take advantage of these services and their innate cost efficiencies, “Telehealth has been undervalued for many years…because the reimbursement climate for telehealth was not favourable.” However today, through the exercise of governmental reforms on the state and federal levels, we have finally broken through the telemedicine payment barrier.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com